Spotlight on Asthma Prescribing

A recent audit of 100,000 patients by the charity Asthma UK indicates that tens of thousands of people in UK are not receiving the correct treatment or benefiting from effective management of their asthma. The charity’s report, ‘Patient Safety Failures in Asthma Care: the Scale of Unsafe Prescribing in the UK’ highlights a number of issues, including:

Misdiagnosis of asthma

Wrongly prescribed medication, e.g. over reliance on long-acting reliever inhalers and under use of preventer inhalers

Missed warning signs of uncontrolled asthma

Asthma UK states that these prevalent issues are putting lives at risk. The UK has one of the highest rates of asthma prevalence, hospital admissions and mortality in the developed world. Dr Mark Levy, GP and author of the National Review of Asthma Deaths, said deaths could be prevented by better disease management.

"We should be assessing and reviewing every patient and reviewing people every time they have an attack. A single review once a year is not acceptable."

Dr Mark Levy
GP and author of the National Review of Asthma Deaths

Asthma UK’s report recommends:

The prescription of a preventer inhaler with every long-acting reliever inhaler

A GP asthma review for those people using of 12 or more reliever inhalers a year and those using a reliever inhaler more than 3 times a week

Asthma UK’s data indicates that of 5.4 million UK residents receiving asthma treatment almost 21,000 adults and 2,000 children may have been given long-acting reliever inhalers alone – instead of in combination with the required inhaled steroids. Also, reliever inhalers in excess of the maximum of 12 per person per year were also commonly prescribed. The charity has described such prescribing as ‘unsafe’, unlicensed’ and ‘putting the lives of patients at risk’.

"It is simply unacceptable that the lives of people with asthma are being put at risk because of unsafe prescribing. The UK has some of the highest mortality rates for asthma in Western Europe and the levels of unsafe prescribing identified in our report today must be stopped."

Kay Boycott
Chief Executive of Asthma UK

A lack of training and education, inadequate systems for identifying and preventing human errors, and a culture that fails to acknowledge the seriousness of asthma are cited as possible causes of the unsafe prescribing.
Healthcare professionals were urged by the charity to implement recommendations from last year’s National Review of Asthma Deaths “as a matter of urgency” to protect people with asthma in the UK from avoidable harm and preventable deaths.

New guidelines on the diagnosis and monitoring of asthma are needed, according to Nice, because ‘there is evidence that incorrect diagnosis is a significant problem’.
Studies suggest up to 30% of people do not have clear evidence of asthma and while some may previously have suffered it, many patients will have been wrongly diagnosed as asthmatic, NICE advisers said.